Evaluation of resident laparoscopic performance using global operative assessment of laparoscopic skills

The Global Operative Assessment of Laparoscopic Skills (GOALS), developed by Vassiliou and colleagues, has construct validity in the assessment of surgical residents' laparoscopic skills in dissection of the gallbladder from the liver bed. We hypothesized that GOALS would have construct validity for the entire laparoscopic cholecystectomy procedure and also for laparoscopic appendectomy.

Using GOALS, attending surgeons evaluated PGY1 through PGY5 surgical resident performance during laparoscopic cholecystectomy (LC, n = 51) and laparoscopic appendectomy (LA, n = 43). Scores for five domains (depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy) were recorded on a Web-based operative report generator at the conclusion of all cases. Domain scores were recorded using a 5-point Likert scale. Difficulty of the case was similarly rated on a 5-point scale. For analysis, residents were divided into two groups: novice (PGY1 to 3) and experienced (PGY4 to 5). Biostatistical analysis was performed using a two-sample t-test. Paired t-test was used to compare mean scores of residents who performed both LA and LC.

For both LC and LA, the experienced group scored higher than novices did in all five domains. The differences were significant in all domains. Using the mean of the scores from all 5 domains for both LC and LA, the experienced residents scored significantly better than novices did (LC 3.93 versus 2.76, p < 0.001) (LA 4.22 versus 2.75, p < 0.001). No significant differences were noted in difficulty of the cases (p = 0.060 for LC and p = 0.19 for LA).

This study provides additional evidence in support of GOALS as an assessment tool for objectively measuring technical skills in laparoscopic surgery.